Chronic subdural hematoma (CSDH) is a common neurosurgical disease, especially in elderly patients, and its treatment currently includes medication conservation, surgical intervention and combination therapy. Although many cases have achieved good results through drug treatment, as far as the present situation is concerned, surgical intervention is still an irreplaceable treatment, especially for patients with large amounts of hematoma, even those with cerebral hernia or recurrence. However, there are many surgical methods about CSDH, the clinical selection is controversial, what is more, there has been some progress in minimally invasive surgery in recent years. In this paper, the surgical methods of CSDH are summarized as follows. The purpose is to provide for clinical evaluation and selection.

Programmed death-1(PD-1)is a major co-suppression receptor expressed on T cells.Binding with its ligands (PD-L1 and PD-L2),PD-1 can inhibit T cell proliferation,activation and cytokine secretion.In normal organs,PD-1 /PD-Ls signaling pathway plays an important role in maintaining immune tolerance,while during tumorigenesis,it can suppress T cell immune response and promote tumor immune escape.This article reviewed the research progress on PD-1 /PD-Ls signaling pathway,comprised of structure and expression of PD-1 /PD-Ls, mechanism of the signaling pathway,as well as the expression characteristics of soluble form of PD-1 /PD-L1 (sPD-1 /sPD-L1),and summarized the categories of anti-PD-1 /PD-Ls antibodies and their clinical trials in canc-er immunotherapy.

According to the Organ Injury Scale Grading System of the American Association for the Surgery of Trauma (AAST-OIS),grade Ⅴ liver trauma is always complicated with retrohepatic inferior vena cava injury and less bile duct injury,and it is extremely severe and difficult to be treated.Timely and fast judgment,emergent exploration and effective repair of the injured bile duct are the key points for the treatment of bile duct injury.One patient with grade Ⅴ liver trauma combined with hilar bile duct transection injury was admitted to the Fuzhou General Hospital of Nanjing Military Command on August 30,2013.The rupture of left and right liver junction was detected by preoperative multidisciplinary consultation and emergency open surgery at admission hour 4.There was left and right hepatic duct bifurcation rupture at the first hepatic hilum.Non-functional liver tissues were excised.Breakage left and middle hepatic vein were sutured by polymer suture line.Liver traumatic bleeding and bile duct were sutured and ligatured individually.Left and right hepatic duct laceration was sutured by 6-0 PDS suture line.A hole in the stomach wall was opened fist,and then most part of the gastric contents was removed and the gastric wall was reparied by stapler.Patient received the postoperative symptomatic treatment with gradual recovery,and was discharged from hospital at admission day 26.The patient was readmitted to the hospital at 31 days of discharge due to outflow of purulent fluid from abdominal cavity drainage tube,and was treated by ceftriaxone sodium and tazobactam sodium according to the results of drug sensitive test and continuous peritoneal lavage.The abdominal cavity drainage tube and left and right hepatic duct drainage tube were removed at postoperative day 83.The patient was discharged from hospital at readmission day 28,and was followed up till December 2014 with good recovery and without complication.

OBJECTIVE:To evaluate the economics of alendronate sodium preventing osteoporotic fractures in postmenopausal women,and to provide reference for osteoporotic and osteopenia patients to select economical and effective therapy plan. METH-ODS:Using Markov economic model,TreeAge Pro 2011 software was used for cost-utility analysis using RCTs literature data of basic medication(calcium and vitamin D3)and basic medication combined with alendronate sodium as baseline data. Using quality adjusted life years(QALYs)and incremental cost utility ratio(ICUR)as economics evaluation indexes,the stability of established model was investigate by single factor sensitivity analysis. RESULTS:QALYs of the basic treatment group was 0.704 years,and QALYs of drug combination group was only 0.708 years. However,ICUR of two groups reached 714252.44. For the late period of hip fracture and other fractures,drug combination group was in high cost and low benefit,obviously had no economic advan-tage. For vertebral fractures,the cumulative probability of fracture in drug combination group was significantly lower than basic treatment group,and ICUR of the two groups was only 13902.17,with economic advantage. For hip fracture,the cumulative prob-ability of fracture in basic treatment group was the same as drug combination group,and ICUR was 19109.00,with economic ad-vantage. For wrist fractures,curative effect and economy needed further study. CONCLUSIONS:For the low-risk population with osteoporotic fractures,calcium and vitamin D3 are more economical in preventing osteoporosis fractures. For the high-risk popula-tion with vertebral and hip fractures,alendronate sodium combined with basic treatment is effective and economical.

Objective To investigate the correlation between plasma homocysteine (Hcy) level and cerebral microbleeds (CMBs) band leukoaraiosis (LA) in patients with acute stroke.Methods The clinical and imaging data of patients with acute stroke were analyzed retrospectively.The numbers of CMBs were counted and the severity of LA was graded according to the results of MRI.Fasting venous samples were obtained and the plasma Hey concentration was measured the next day after admission.Results A total of 139 patients with acute stroke were enrolled,67 of them were females and 72 were males (mean age 70.1 ± 10.2 years); 24 had hemorrhagic stroke and 115 had ischemic stroke.The age (76.23 ± 8.74 years vs.64.58 ± 7.42 years;t =4.621,P =0.012) hypertension ratio (89.13％ vs.67.74％ ;x2 =8.324,P =0.0 370) and plasma Hey level (14.53 ± 4.31 mmol/L vs.11.31 ±3.16 mmol/L;t =6.538,P=0.008| in a severe LA group (n=46) were significantly higher than those in a non-severe LA group (n =93).Spearman correlation analysis showed that there was significant correlation between the plasma Hcy level and the severity of LA (rs =0.365,P =0.002).Multivariate logistic regression analysis showed that the increased Hey level (odds ratio [ OR ],1.366,95％confidence interval [ CI] 1.141 - 1.526; P =0.010) and age (OR 1.093,95％ CI 1.031 - 1.162; P =0.016)were the independent risk factors for severe LA.The age (74.37 ± 6.35 years vs.67.56 ± 8.52 years; t =6.628,P =0.038) and hypertension ratio (94.74％ vs.62.20％;x2 =8.773,P =0.002) in a CBM group were significantly higher than those in a non-CMB group (n =82).Spearman correlation analysis showed that there was no significant correlation between the plasma Hcy level and the numbers of CBMs (rs =0.038,P =0.813).Multivariate logistic regression analysis showed that hypertension was an independent risk factor for CBMs.Conclusions The elevated plasma Hcy level was associated with LA,but it was not associated with CBMs.

OBJECTIVE To investigate the effect of ferulic acid(FA)on motor function of rats with a spinal cord injury model(SCI)and its possible effects on expression of microtubule-associated protein light chain 3(LC3),Beclin1,Bcl-2 and Bax. METHODS SD rats were randomly divided into 3 groups:sham group,SCI group,FA(100 mg·kg-1,po)group. Rats were subjected to moderate contusion inju?ries using a vascular clip for 2 min to establish an SCI animal model beforfe they were given BBB scores and inclined plate scoring function test on 6 h,1,3,7 and 14 d after SCI. After the test,rats were sacrificed. Spinal cords were observed by hematoxylin eosin(HE)staining. Furthermore,the expressions of LC3,Beclin1,Bcl-2 and Bax were detected by Western blotting. RESULTS Compared with the sham group,BBB scores and inclined plate function scores significantly decreased in model group. The BBB scores decreased from 21 in sham group to(0.5±0.5)in SCI group,and inclined plate function scores decreased from 70° in sham group to(5.8±2.0)° in SCI group. However,this was reversed by FA treatment. BBB scores and inclined plate function scores increased from 3.0 ± 1.7 to 6.2 ± 3.6(P<0.05)and from (13.3 ± 4.1)° to(26.7 ± 8.7)°(P<0.05)after FA was po given for 7 d,respectively. HE staining showed the gradual emergence of internal spinal cord edema,while the structural changes associated with spinal cord injury could be significantly reversed by administration of FA. Moreover,the expression of LC3-Ⅱ/LC3-Ⅰand Beclin1 was significantly increased in SCI 1 d group(P<0.01),but was decreased in 14 d group when compared with SCI 1 d group(P<0.05). The expression of Bcl-2 was increased in SCI 14 d group,and the ratio of Bcl-2/Bax was increased on 14 d after SCI(P<0.05). Compared with the SCI group,LC3-Ⅱ/LC3-Ⅰand Beclin1 expression was increased in FA-treated 1 d group(P<0.05),Bcl-2 expression was increased in FA-treated 14 d group and the ratio of Bcl-2/Bax was significantly increased on 14 d after SCI(P<0.05). CONCLUSION FA has a therapeutic effect on SCI,which may be related to the impact of neuronal autophagy and apoptosis. Meanwhile,autophagy of SCI may be a process of gradual enhancement followed by weakening,and the anti-apoptosis effect may gradually increase with autophagy.

Objective To establish and improve the acute hepatic failure model in pigs induced with D-galactosamine (D-gal),and explore the feasibility of evaluating preclinical artificial liver devices.Methods Nineteen Duroc breeding pigs were divided into 4 groups.Fifteen unanesthetic Duroc breeding pigs out of 19 (5 of each group) received intravenously administration of D-gal at a dose of 1.0,1.25 and 1.5 g/kg body weight,respectively.The remaining 4 pigs which received the same volume of 5% dextrose in water served as controls. Clinical data and survival time of pigs were recorded.Blood samples were collected for dynamic testing of plasma ammonia,prothrombin time,liver and renal functions,blood glucose and L-lactate;liver tissues were sampled for pathological examination.The differences between groups were compared using t test and F test.The survival time of pigs was compared by Kaplan-Meier survival analysis and Log Rank test.Results Twelve hours after administration of D-gal,all pigs presented as acute hepatic failure characterized by progressive increases of levels of plasma ammonia,aspartate aminotransferase (AST),total bilirubin (TBil) and L-lactate,the level of blood glucose marked decreased and prothrombin time prolonged (F= 32.33,F=27.817,F=50.097,F=88.382,F=8.211,F=21.227;all P＜0.01);especially in the pigs which received D-gal at a dose of 1.5 g/kg.Except 2 pigs survived for 168 h,the other 3 pigs which received D-gal at a dose of 1.0 g/kg died within 68-84 h,while all pigs which received D-gal at a dose of 1.25 and 1.5 g/kg died within 33-89 h and 23-47 h,respectively.All pigs presented coma before death and liver histopathological examination indicated massive hepatic necrosis with severe hemorrhage.Conclusions D-gal induced acute hepatic failure model in unanesthetic Duroc breeding pig appears potential reversibility and high reproducibility,which has proper therapeutic window.Thus,this model could be applied to evaluate the therapeutic effects and safety of artificial liver devices.

Objective To investigate the clinical effect of cryosurgery in the preoperative preparation of liver transplantation in treating liver cancer.Method This study reviewed retrospectively clinical data from 74 patients who underwent cryosurgery of liver cancer before liver transplantation.According to the differences between transplantation programs,74 patients were divided into 2 groups:26 patients in Argon-helium cryoablation group (AHC group) and 48 patients in transcatheter arterial chemoembolization group (TACE group).Whether the patients in two groups met the standard of Milan after treatment,as well as the incidence rate of complication,waiting time for transplantation and MELD score before transplantation were compared between two groups after preoperative therapy.What's more,operation time,no liver time,amount of bleeding,PT and serum level of aminotransferase at 1st,3rd,and 5th day after transplantation were analyzed.Abdominal drainage fluid volume,the incidence of infection,acute rejection,kidney failure,biliary complication,and vascular complication in two groups were also compared.Disease free survival rate was counted after two years by outpatient follow-up.Result Only 3 cases in two groups exceeded Milan standard after treatment,one in AHC group and two in TACE group.The complication incidence and waiting time in two groups had no statistically significant differences.The MELD score in AHC group was significantly lower than in TACE group before transplantation.The operation time,amount of bleeding and transfusion requirements in AHC group were also significantly lower than in TACE group.The time without liver in two groups had no statistically significant difference.The speed of liver function recover was faster in ACH group,and the abdominal drainage fluid volume was less.There were no significant differences in incidence of postoperative complications between two groups (P＞0.05).Conclusion Cryosurgery therapy has little effect on liver functions after treatment.It is a good therapy for liver cancer patients before liver transplantation.

Objective To investigate the protective effect and the possible mechanism of Wenshen Shengjing Decoction (WSSJD)(including Cornu Cervi Nippon Parvum , Panax ginseng, Cynomorium songaricum, Cistanche deserticola,Radix Astragali, Epimedium brevicornum, Angelica sinensis.) on cyclophosphamide induced testicular oxidative damage in mice . Methods Eight-week-old male Kunming mice were assigned .Mice in normal control group received intraperitoneally nor-mal saline, and mice in Western medicine group ,WSSJD group and model group were injected intraperitoneally with cyclo-phosphamide [80 mg/(kg? d) ]for five days.Then mice in Western medicine group and WSSJD group were gavaged with clomifene citrate or WSSJD for 30 days consecutively .The epididymal sperm count and sperm viability were recorded , and the structure of seminiferous epithelium was observed .The content of malondialdehyde (MDA) and glutathione (GSH), and activities of glutathione peroxidase ( GSH-Px) and catalase ( CAT) in testicular tissue were detected .Immunohisto-chemical technique was used to detect the expression of survivin in spermatogenic cells .The apoptosis of spermatogenic cells in the testes was detected by TUNEL assay .Results Compared with model and Western medicine groups ,the epidid-ymal sperm count and sperm viability rate , the development of seminiferous epithelium , and the activities of GSH-Px and CAT significantly increased , while the MDA content significantly decreased in WSSJD group .The expression of survivin in spermatogenic cells was significantly improved .The apoptotic indexes of seminiferous tubules and spermatogenic cells significantly decreased in WSSJD group .Conclusion These results suggest that WSSJD can significantly improve the impaired reproductive function induced by cyclophospamide in mice by enhancing the antioxidative capability in testes and reducing the apoptosis of spermatogenic cells .

Objective To observe the influencing of Yiqi Huayu Jiedu Prescription on the growth of HepG2 nude mice transplantation tumor and the expression of related factors of vascular mimicry. Methods Models of transplanted tumors, which were made by HepG2 cells in nude mice, were randomly divided into 7 groups, Yiqi Huayu Jiedu Prescription group, Astragali Radix group, Curcumae Rhizoma group, Paridis Rhizoma group, Gecko group, cis-platinum group, and model group. Except for the model group, the rest groups were given relevant medicine for intervention. 21 days later. HIF-1α, MMP-2, MMP-9, and E-cad were detected by immunohistochemistry, and Twist1 and Bcl-2 were detected by fluorescence quantitative PCR. Results Compared with the model group, tumor volume in the rest groups decreased (P<0.05), and the effect in the Yiqi Huayu Jiedu Prescription group was more obvious than the Astragali Radix group, Paridis Rhizoma group and Gecko group (P<0.05);The expression of vasculogenic mimicry structure was rare in each group, and the model group and cis-platinum group were the most obvious;Except for the Astragali Radix group, the expressions of HIF-1α, MMP-2, and MMP-9 showed statistical significance compared with model group (P<0.05);The expression of E-cad in the Yiqi Huayu Jiedu Prescription group and Astragali Radix group showed statistical significance (P<0.05);The expression of Bcl-2 in the Yiqi Huayu Jiedu prescription group, Paridis Rhizoma group, and Gecko group decreased significantly compared with the model group (P<0.05);The expression of Bcl-2 in the Yiqi Huayu Jiedu prescription group was much better than the other groups (P<0.05);The expression of Twist1 showed statistical significance in the Yiqi Huayu Jiedu Prescription group, Curcumae Rhizoma group, Paridis Rhizoma group, and cis-platinum group (P<0.05). Conclusion Yiqi Huayu Jiedu Prescription can reduce expression of HIF-1α, Twist1, Bcl-2, MMP-2, and MMP-9, and increase expression of E-cad, thereby inhibiting the formation of vascular mimicry.